Accelerating e-Prescribing

CHT Launches Health Based Health Reform at Washington Press Club Event

Adopting health information technology and electronic health records could save the federal government as much as $40 billion a year by reducing fraud and abuse in Medicare and Medicaid, members of the Center for Health Transformation said at a forum Monday.  "A paper-based, bureaucratic system invites entrepreneurial crooks," said former Republican House Speaker Newt Gingrich, the center's founder. "The crooks can leave faster than you can audit the paper . . . Electronic health records and interoperability [are] key to the health care system we want to have."

The stimulus package currently under congressional consideration would provide about $18 billion to help physicians, hospitals and other health care providers cover the costs of the necessary computers and software. The measure would offer incentive payments to doctors and hospitals to adopt health IT. Doctors and hospitals who do not adopt electronic records would be penalized with reduced Medicare payments.

At Monday's launch of the Center's latest initiative -- health-based health reform -- health and healthcare experts cited dozens of egregious examples of fraud, including a dentist in New York who filed claims that he performed more than 900 procedures in a single day and millions of dollars billed by doctors who had died.

Merrill Matthews, director of the Council for Affordable Health Insurance, said Medicare could save billions of dollars by simply reducing the numbers of fraudulent claims. While critics often complain that private insurers spend more on administrative overhead, some of those expenses arise because private companies are more vigilant about monitoring claims for fraud, he said. "Medicare has simply never been able to get fraud under control," Matthews said. "You just don't hear about the kind of fraud in the private sector that you do in Medicare."

Congress also should consider amending the Congressional Budget Act of 1974 (PL 93-334) so that the federal budget could better distinguish between costs and investments, Gingrich said.  Under the current scoring models, the Congressional Budget Office often does not consider a proposal's projected savings when estimating how much it will cost. For example, Gingrich noted that former National Institutes of Health (NIH) Director Elias Zerhouni said that $10 billion the US invested in HIV research has saved about $1.4 trillion in health care expenditures.  

Investing in basic research, particularly brain research, at the NIH and the National Science Foundation could recoup billions later on by delaying the onset or reducing cases of Alzheimer's disease, Gingrich said.

Will Carrot and Stick Approach Work?

The federal government beleives that both carrots and sticks must be used to migrate the healthcare community to an electronic platform.  Earlier this year, Medicare began providing physicians with an incentive bonus (2% in 2009) for using electronic prescribing for their patients. The incentive will slowly decrease and ultimately turn into a penalty for physicians who refuse to embrace e-prescribing by 2011.

Now, the US Senate Committee looking at President Obama’s economic stimulus package is considering the same approach. The first glimpse of the Senate legislation for funding health IT reveals that both incentives and penalties are necessary to persuade providers to adopt electronic health records. While no mandate is mentioned in the Senate Finance Committee portion of President Obama’s economic stimulus package, it is beleived that hospitals and physicians which participate in Medicare or Medicaid and acquire EHRs would be eligible for temporary bonus payments from 2011 to 2015. Physician offices could receive up to $15,000 the first year, and the annual payments would decline annually, sinking to $2,000 in the final year. Providers who didn’t adopt certified EHRs by then would start seeing CMS payment reductions of 1 percent each year.

Starting in 2011, hospitals would receive additional Medicare payments of at least $2 million, which would phase down annually to 75 percent of the initial amount, then 50 percent, and finally 25 percent. These numbers would vary, depending on when the hospital shows that it’s using the technology “in a meaningful way,” according to a published report. It’s not clear whether hospitals that didn’t implement EHRs would be financially penalized.

The physician health IT incentives resemble those that CMS recently started offering for the adoption of electronic prescribing. Although this program took effect on Jan. 1, the anticipation of the 2 percent bonus has already prompted a significant number of physicians to begin e-prescribing.

Meanwhile, the Senate version of the stimulus package includes$3 billion more for health IT than does the House version, which calls for $20 billion to be spent on HIT. The Senate Finance Committee is expected to approve nearly $18 billion for HIT. The Senate Appropriations Committee is set to appropriate an additional $5 billion, but details of that spending are not yet available.

Will carrots and sticks be enough to help? Well, if the e-prescribing bonus is any indication, it certainly can't hurt.

Wall Street Journal: Incentives Push More Doctors to e-Prescribe

According to an article published in the Wall Street Journal, "with a host of new incentives, doctors are finally beginning to scrap pen and paper in favor of electronic prescriptions."  As most CHT members know, on January 1, 2009, Medicare began paying doctors a bonus if they use e-prescribing solutions for their patients. Some private health plans also have begun offering incentive payments or free equipment, digital handheld devices or technical support. And NEPSI is offering free software to physicians to encourage them to move away from paper prescriptions. As a result, "the number of physicians prescribing medicines electronically has more than doubled in the past year to about 70,000, or about 12% of all office-based doctors."

But, the Wall Street Journal reports that there are still barriers to "full-fledged adoption of e-prescribing. Federal drug laws, which are under review, prohibit electronic prescribing of controlled medications such as narcotics, insomnia drugs and anti-depressants. Safety experts also warn that selecting prescriptions on a computer screen can cause a doctor to inadvertently enter, for instance, a quick-release version of a drug instead of a long-acting formulation because they appear in sequence on an e-prescribing program."

"There are more than 1.5 million people hurt every year by preventable medication errors, and the evidence is strong that patients are far better off when we e-prescribe than when we don't," says Janet Marchibroda, chief executive of eHealth Initiative, a nonprofit that includes public-health agencies, consumer groups, health plans and technology companies.

Electronic-prescribing systems also can save patients money by allowing doctors to check, with a patient's consent, the relative cost of co-payments for generic, formulary and nonformulary drugs in a patient's health plan. The main software program being offered free to doctors, by Allscripts Inc. and a coalition of technology companies and health plans, displays a green smiley face next to generic and on-formulary drugs, and a red frowning face next to more expensive nonformulary drugs.

In a study published last month in the Archives of Internal Medicine, researchers at Brigham and Women's Hospital found that e-prescribing systems that allow doctors to select generic or lower-cost medications can reduce annual costs of delivering drugs to consumers by $845,000 for every 100,000 patients.

Virtually all chain pharmacies and about 45% of independent pharmacies now accept electronic prescriptions, says Rick Ratliff, co-chief executive of SureScripts-RxHub. The company, which has patient information from pharmacy-benefit managers, operates the main network over which prescriptions are transmitted electronically. The company stores data on more than 200 million insured patients and provides physicians with ready access to information on patients' medication histories and which medicines are covered by their health plans.

E-prescribing also is expected to encourage broader use of electronic medical records, which includes such features as storage of full medical histories, lab reports, and programs that let doctors send alerts and reminders to patients. The cost of the technology to maintain full electronic medical records is roughly $25,000 to $45,000 per physician. While free software and hardware programs are being offered to some doctors, generally the cost of a stand-alone e-prescribing system, including software and training, ranges from $500 to $2,500. The system can later be incorporated into a medical-records system.

Senate Committee Examines HIT in Stimulus Package

According to CongressDaily, the Senate Health, Education, Labor and Pensions Committee held a hearing on the inclusion of health information technology funding in the economic stimulus package. The House's version of the $825 billion economic stimulus package includes $20 billion for health information technology. At the hearing, Sen. Barbara Mikulski (D-Md.) warned against moving too quickly on similar Senate legislation. She added that HIT legislation should be "patient-centered and patient-secure" and should facilitate interoperability. Mikulski also noted that about 4% of U.S. physicians currently use electronic health records, but failure to make those records interoperable between hospitals and other health care facilities has affected efficiency and patient care. Mikulski said that the Senate Appropriations Committee's mark up of the economic stimulus bill likely would occur before February. She declined to say whether the Senate version of the bill would include the HIT provision included in the House's version.

Health Care Opinion Leaders Overwhelmingly Support HIT in Stimulus Package

According to WebWire, leaders in health care and health care policy feel strongly that President-elect Barack Obama should pursue an ambitious health care reform agenda that expands coverage while also improving quality and efficiency, and controlling costs. In fact, two-thirds (66%) of those surveyed in the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey said that the new administration should pursue these goals simultaneously.

When asked which features were important to act on immediately, an overwhelming majority—83 percent—said expanding the State Children’s Health Insurance Program (SCHIP) was absolutely essential or very important. Investment in health information technology (HIT) in the economic stimulus package (supported by 78%), and access to public health insurance coverage for the long-term unemployed (supported by 72%) were also seen as crucial.

The survey asked respondents to identify what they think the incoming Obama administration should make its top health care priorities. There was widespread support for many elements of President-elect Obama’s health care reform proposal, including allowing uninsured people to buy health insurance through a health insurance exchange (favored by 92%) and expanding eligibility for Medicaid and SCHIP to low-income adults and children (favored by 89%). Survey respondents were, however, sensitive to the realities posed by the current economic crisis. When asked how the administration should prioritize reform measures if they needed to happen in phases, a wide majority felt that Medicaid and SCHIP eligibility expansion (82%) and funding for HIT (76%) should be part of phase one.

Overall, there was wide agreement that the President-elect and his team must move ahead with health care reforms. "The election of the new administration and Congress has opened up a historic opportunity for health care reform—one that could finally give Americans the health security they need and deserve" said Commonwealth Fund President Karen Davis. "Health care opinion leaders agree that focusing on the right policies and priorities can really put the U.S. on the path to a high performance health care system." 

PCMA: HIT Stimulus Package Has Potential for Huge Success

As leaders in Congress and in the Obama transition team consider the inclusion of health information technology provisions in the economic recovery package, the Pharmaceutical Care Management Association (PCMA) has offered guidelines to ensure that any new HIT investments would accomplish the desired goal of avoiding wasteful spending.  “HIT legislation presents an opportunity for huge success if policymakers ensure that all electronic medical records include basic safety tools like e-prescribing, which improves efficiency, affordability, and access,” said PCMA President and CEO Mark Merritt.  “However, spending billions on new HIT systems that don’t include e-prescribing, are not interoperable with other EMR technologies, or contain unworkable privacy provisions would be more than just a waste of money.  It would waste an historic opportunity to improve chronic care and prevent countless medical errors and hospitalizations.”

PCMA has specifically recommended the following five guidelines:

    1. Increase accountability by rewarding the use – not simply the purchase – of EMR technologies.  Build on the accountability provisions in Medicare’s new e-prescribing incentives program which specifies that funds only go to providers who actively use the technology.

    2. Fund only those EMRs which use “real” e-prescribing, as defined in Medicare. In the Congressional Budget Office’s (CBO) definition of HIT, all “qualified” EMRs must have e-prescribing capability, yet less than 50 percent of currently used systems do.  Many simply print outor file prescriptions, but do not enable providers to prevent dangerous “drug-drug” interactions.  Building upon the success of last year’s Medicare bill (that is expected to increase provider adoption of e-prescribing to 40 percent within the next five years), new HIT funding could nearly double that adoption rate within the same period if done correctly.

    3. All qualified HIT must be certified by a third party as meeting national interoperability standards.  Providers and the government need assurances that all HIT systems are able to communicate with each other.

    4. Support President-elect Obama's five year plan for HIT investment.  President-elect Obama's goal is for all medical records in America to be computerized within five years. To ensure accouontability and avoid waste, there must be a clear commitment to achieve this important goal.

    5. Privacy is important ... but so is patient safety. Privacy should be considered in the broader HIT context of encouraging adoption of technologies that improve health care safety and efficiency. It would be an unfortunate irony if any new privacy provisions (i.e. beyond HIPPA) resulted in higher cost, increased inefficiency, lower provider adoption, and less patient access to life-savings technologies.

 

 

 

National Business Group on Health Calls for HIT Investment

Accrording to CQ HealthBeat, the National Business Group on Health has asked members of Congress and the transition team of President-elect Barack Obama for funds for comparative effectiveness research, health care information technology, and subsidies for COBRA benefits in an economic stimulus package.

NBGH President Helen Darling said at a hearing that the stimulus package should include $1 billion for comparative effectiveness research, which would help physicians to determine the most effective treatments for patients based on scientific evidence.  The Agency for HealthCare Research and Quality could oversee the research, Ms. Darling said. She also said that the stimulus package should include an investment in health care IT, despite the current lack of a broad set of interoperability standards. She said, "Health IT is an area where there are a lot of different ways to spend money and still be effective."

In a recent letter to congressional leaders, Ms. Darling wrote, "We must tackle these extraordinary complex issues now because the nation will not be able to pull out of this deep recession while health care costs continue to work against businesses' ability to grow jobs and compete globally."

The Boston Globe reports that some industry experts believe that the inclusion of an investment in health care IT in the economic stimulus package could lead to wider adoption of electronic health records. According to experts, such an investment could provide physicians with financial incentives to adopt EHRs, electronic prescribing and other forms of health care IT.

However, many experts have raised concerns about the interoperability, implementation and privacy issues associated with such an investment. According to Roll Call, number of groups -- such as Patient Privacy Rights, the American Civil Liberties Union, the National Association of Social Workers and the AIDS Action Council -- have asked congressional leaders to address those concerns before they make large investments in health care IT. Other groups have said that the stimulus package should include interoperability standards for health care IT.

President-elect Calls for EHRs for All in Five Years

In a major speech on January 8th to push his forthcoming economic stimulus package, President-elect Barack Obama pledged to have all medical records electronic within five years.

"To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that within five years, all of America's medical records are computerized," Obama said. "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests. But it just won't save billions of dollars and thousands of jobs, it will save lives by reducing the deadly but preventable medical errors that pervade our health care system."

According to Health Data Management, President-elect Obama did not specify the level of support the federal government would give to help providers automate medical records. During the presidential campaign, he pledged to commit $50 billion over five years to support adoption of standards-based information systems and the national health information network.

Zix Corp. and United Healthcare Create Partnership to Accelerate e-Prescribing in Texas

Two CHT members have joined forces to accelerate the adoption of e-prescribing. Accroding to the Dallas Business Journal, Zix Corporation has partnered with UnitedHealthcare to offer electronic prescribing technology to Texas physicians. The two companies started offering ZixCorp’s e-prescription technology at discounted rates to 200 primary care and specialty physicians in Austin and San Antonio, said Rick Spurr (pictured above), chairman and CEO of Zix Corporation.

According to UnitedHealthcare, as part of the program, UnitedHealthcare will pay 75% the upfront cost of the hand-held PDA e-prescription devices. The technology will allow physicians, nurses and other medical office staff to look up patients’ drug histories, check for adverse drug interactions and allergies and send prescriptions to pharmacies electronically with a touch of a button.

Tennessee Leaders Commit to Accelerating Adoption of e-Prescribing

According to the Nashville Tennessean, the State of Tennessee has come a long way in a short time when it comes to using electronic prescribing as the primary way health care providers dispense prescriptions.  In an op-ed which appeared in the Tennessean, Health Commissioner Susan Cooper and Finance Commissioner Dave Goetz said, "E-prescribing is the secure, electronic transmission, from a medical provider's computer to a pharmacist's computer, of a patient's prescription that needs to be filled or re-filled."

Tennessee Gov. Phil Bredesen recently met with Tennessee health-care leaders to launch e-Prescribe Tennessee, a collaborative framework of health-care industry stakeholders that will work to accelerate e-prescribing adoption in the state. E-Prescribe Tennessee will have doctors, pharmacists, nurses, and other public and private sector health care leading the organization. This group is similar to CHT's Georgia e-Prescribing Collaborative and will be focused on building cooperation and coordination among prescribing constituents and on educating consumers about the benefits of e-prescribing.

Improved patient safety, efficiency and quality of care for patients in Tennessee are at the center of e-Prescribing Tennessee. "E-prescribing offers the ability to protect the privacy of patients and quickly authenticate prescribers," the op-ed noted. "Of benefit to the prescriber is the ability to check instantly on a patient's prior reactions to medications and other patient-specific factors, as well as dosage levels and possible interactions with already prescribed medicines. The prescriber also has the ability to check the status of a prescription, determining if the medication was picked up or not. This improves care by helping the prescriber know if a patient is following instructions, which is vital in care of chronic conditions like diabetes, heart disease and high blood pressure."

Just as CHT is working with physicians, pharmacists, hospitals, insurers, employers, vendors, community leaders and state agencies in Georgia, the leaders in Tennessee understand the importance of working together to accelerate e-prescribing adoption.